Infections of the respiratory system Flashcards

1
Q

What is pneumonia

A

‘chest infection’, refers to lung inflammation
associated with consolidation or infiltrates secondary
to infection.

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2
Q

what are the different types of pneumonia?

A
  1. Community-acquired pneumonia (CAP) refers to
    patients with a pulmonary parenchymal infection
    who present with symptoms of an acute infection
    from the community
  2. Hospital-acquired pneumonia (HAP) presents after
    at least 48 hours in a hospital setting

3.Healthcare-associated pneumonia (HCAP) refers
to pneumonia that develops in patients who
reside in nursing homes, long-term care facilities
or haemodialysis centres or who have had recent
chemotherapy

  1. Aspiration pneumonia is caused by inhalation
    of contents (e.g. vomitus) in patients with
    altered mental status/stroke, causing lung
    injury and subsequent infection; treatment is
    with intravenous antibiotics and supportive
    care
  2. Ventilator-assisted pneumonia is likely to occur
    48–72 hours after endotracheal intubation

6.Pneumocystis jirovecii pneumonia (previously
known as Pneumocystis carinii pneumonia or
PCP) is caused by an opportunistic infection in
HIV patients; diagnosis is made by identifying
the organism in sputum; treatment is with
co-trimoxazole

  1. Atypical pneumonia (e.g. mycoplasma)
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3
Q

What are the typical causes of pneumonia

A
  1. Strep. pneumoniae. the most common cause of CAP. Elderly and immunocompromised
  2. Staph.aureus. occurs in infulenza infection
  3. Klebsiella pneumoniae. Alcoholics and diabetics
  4. Legionella. Air conditioning or travel history to a foreign country. (hyponatraemia and deranged LFT)
  5. Mycoplasma. erythema multiforme, cold autoimmune haemolytic anaemia. Treat with erythromycin.
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4
Q

Strep. pneumoniae common in?

A

in CAP. Elderly and immunocompromised

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5
Q

Staph.aureus is associated with?

A

influenzas infection

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6
Q

Klebsiella pneumoniae. is associated with?

A

Alcoholics and diabetics

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7
Q

Legionella pneumonia is associated with?

A

Air conditioning or travel history to a foreign country. (hyponatraemia and deranged LFT)

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8
Q

Mycoplasma pneumonia is associated with?

A

erythema multiforme, cold autoimmune haemolytic anaemia. Treat with erythromycin.

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9
Q

Clinical features of pneumonia?

A

Fever

Cough with purulent sputum which may be blood-stained

Shortness of breath

Malaise, loss of appetite and myalgia

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10
Q

is the lower respiratory tract sterile?

A

The lower respiratory tract typically remains sterile

because of pulmonary defence mechanisms

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11
Q

Investigations of pneumonia?

A

CXR

Bloods: FBC, U&E, LFT

Sputum, MS&C

urinary antigen for Legionella

serology for mycoplasma

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12
Q

What is CRUB-65?

A

tool in predicting
30-day mortality in community-acquired
pneumonia.

•Confusion (abbreviated mental test 
score <8)
• Urea >7
• Respiratory rate >30
• BP <90 OR DBP <60 (either one scores one 
point; if both are present, the score remains 
one point for both)
• 65 – Age ≥65
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13
Q

Management of CAP penumonia

A
  1. CURB-65 score. 0-1: Amoxicillin 500mg TDS OR clarithromycin
    500mg BD for 5 days (oral)

2.If CURB-65 score 2, inpatient treatment
(moderate)
• Amoxicillin 500mg tds AND clarithromycin
500mg bd for 7 days (oral or IV)

3.If CURB-65 score ≥3, consider ITU 
admission (severe)
• Co-amoxiclav 1.2g TDS IV AND clarithromycin 
500mg BD IV for 7 days
• Consider ICU involvement
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14
Q

Management of HAP penumonia

A

Offer antibiotic therapy as soon as
possible, and certainly within 4 hours of
diagnosis

Consider a course of antibiotics for 5–10
days in accordance with local hospital
protocol for HAP

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15
Q

What is lung abscess

A

necrotic lung tissue and cavity

formation secondary to infection.

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16
Q

risk factor of lung abscess

A

alcohol excess, diabetes, cystic fibrosis and
risk factors for aspiration are at much greater risk of
developing an abscess

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17
Q

Primary disease for lung abscess

A

Existing pneumonia or lung disease

Untreated pneumonia can cause abscess
formation

18
Q

Secondary disease for lung disease

A

Aspiration
Alcoholics
Septic emboli from right-sided infective
endocarditis

19
Q

clinical feature of lung abscess

A

Swinging fevers
Night sweats
Productive cough with purulent sputum

20
Q

Management o lung abscess

A

Diagnosis is made on CXR, CT and sputum culture.

Bronchoscopic aspirates can be assessed for
organisms, and may also provide symptomatic relief.

Treat with IV broad-spectrum antibiotics; the majority
of cases will resolve. If refractory to medical therapy,
surgical resection may be considered.

21
Q

What is tuberculosis?

A

granulomatous
disease caused by mycobacteria, the most common
of which is M. tuberculosis.

Can have both pulmonary and extra-pulmonary signs

22
Q

name some clinical features of TB

A
expectorant cough
fever
haemoptysis
malaise
weight loss
23
Q

name some extra-pulmonary features of TB

A
arthritis
meningitis
pott spin
erythema nodosum
finger clubbing
24
Q

what are the risk factors of TB

A

alcoholics
homelessness
immunocompromised

25
Q

what is someone infected with TB

A

mycobacteria is engulfed in droplets, and replicates within alveolar macrophages

26
Q

which part of the lung does TB commonly affect?

A

TB typically affects the apical and upper
zones of the lungs. The reason for this is not
completely understood, but it is thought to
occur here because these parts of the lungs
have better air flow and reduced lymphatic
drainage.

27
Q

name some investigations of TB

A

CXR

sputum sample. 3 of them, one must be early morning. NAAT should be used

Blood tests

MAntoux (tuberculin) skin test

28
Q

which stain is used to look for acid-fast bacilli in TB

A

Ziehl-Neelsen

29
Q

what is the name of culture used in TB

A

Löwenstein–Jensen medium, and it takes 4–8 weeks

30
Q

Management of TB

A

isolate the patient

2 months: isoniazid, rifampicin, pyrazinamide, ethambutol

4 further months of: isoniazid, rifampicin

31
Q

side effect of isoniazid

A

soniazid (Iso-neuro-zid) – peripheral
neuropathy (supplement with Vit B6 to
prevent), agranulocytosis, hepatitis

32
Q

side effect of ethambutol

A

(Eye-thambutol) – optic

neuritis, renal impairment

33
Q

side effect of pyrazinamide

A

Pyrazinamide (Pyr-ouch-zinamide) –
hyperuricaemia causing gout, myalgia and
hepatitis

34
Q

side effect of rifampicin

A

Rifampicin (Red-famipicin) – reddish

orange secretions, hepatitis

35
Q

what is aspergillus?

A

a group of fungal moulds that may precipitate lung disease.

36
Q

what are the cutaneous features of aspergillosis

A

cellulitis
ulcers with necrotic centres

treat with voriconazole

37
Q

what is an aspergilloma?

A

also known as a mycetoma, is
essentially a fungal ‘ball’ that is located in a lung
cavity, usually secondary to another disease
process such as TB

38
Q

what is the treatment of aspergilloma?

A

surgical removal of the

aspergilloma, with long-term itraconazole

39
Q

what is Allergic bronchopulmonary

aspergillosis (ABPA)

A

characterised by respiratory difficulty caused
by a hypersensitivity reaction to Aspergillus spp., often
seen in patients with a history of atopy.

40
Q

what is ABPA common in?

A

asthma or cystic fibrosis

41
Q

treatment of ABPA

A

1.oral CORTICOSTEROIDS and
ITRACONAZOLE

2 Steroid therapy may be required for up
to 6 months

3 Prescribe bronchodilator treatment for
asthma and manage cystic fibrosis as
per recommendations. SABA, LRA